动态脑电图监测对癫痫诊断和鉴别诊断的意义

目的探索24h动态脑电图(AEEG)对癫痫诊断和鉴别诊断的意义。方法对225例临床确诊为癫痫及121例非癫痫性发作性疾病患者的AEEG诊断行回顾性分析。结果AEEG与EEG的异常率及痫样放电检出率均有非常显著性差异(P<0.01)。AEEG描记中睡眠期痫样放电检出比清醒期增加15.6%,且57.8%出现在NREM1～2期。癫痫组与非癫痫组两组之间异常率和痫样放电检出率均有显著性差异(P<0.05)。睡眠纺锤波的缺如及减弱,对癫痫患者具有重要的脑电图意义。AEEG可以记录到癫痫发作起始时的波形变化。结论AEEG对癫痫的诊断、鉴别诊断和治疗有重要意义。     

视频脑电图监测在脑瘫合并癫痫患儿中的应用

目的探讨分析视频脑电图监测在脑瘫合并癫痫患儿中的临床应用价值。方法选取2012年4月至2015年1月我院收治的120例脑瘫合并癫痫患儿作为研究对象,按发作状况分为有发作组和无发作组,每组各60例。患儿均采用视频脑电图进行监测,比较两组的监测结果。结果有发作组38例患儿诊断出癫痫发作,占比为63.33%;22例未诊断出癫痫发作,包含14例睡眠肌阵挛,3例夜惊,5例磨牙。无发作组中25例患儿诊断出癫痫发作,占总比为41.67%;35例未诊断出癫痫发作,包含21例睡眠肌阵挛,6例夜惊,8例磨牙。两组癫痫发作发生率比较,差异具有统计学意义(P<0.05)。结论脑瘫合并癫痫患儿在治疗期间,针对发作间歇期患儿可给予视频脑电图进行监测,此监测方式对脑瘫合并癫痫患儿的进一步治疗和预后状况均具有较好的效果,其临床价值较大,可大力推广和应用。     

视频脑电图在小儿癫痫诊断中的应用价值

目的通过视频脑电图（Video-EEG）在癫痫患儿中的临床应用,判断其发作类型和定位,提高对癫痫患儿的诊断水平。方法采用SOLARl848定量数字视频脑电图仪,对407例发作性疾病患者进行连续监测（包括清醒、睡眠期）,分析临床发作和异常放电的关系、癫痫分型与异常放电的关系等。结果407例中101例（25%）在发作问期或发作期发现癫痫样放电,57例（14%）为非癫痫样发作,79例（19％）监测到癫痫样放电与临床发作同步出现,170例（41170）监测中未见发作,且发作间期无癫痫样放电,确诊的病例中例60％重新明确癫痫分型,42％患儿找出了放电的起源。结论视频脑电图在排除非癫痫发作,明确发作类型和定位,评价脑电图与临床关系,提供可靠正确的依据,提高了癫痫的临床诊断水平。     

24例中央及颞叶儿童良性癫痫的临床及脑电图分析

目的 探讨中央及颞叶儿童良性癫痫（BECCT）的临床特征及脑电图（EEG）特点.方法 对24例中央及颞叶儿童良性癫痫的临床表现及脑电图资料进行回顾性分析.结果 该组患儿年龄为3～12岁,90%病例癫痫发作与睡眠有关.以部分性运动为主要表现,少数可发展为强直-阵挛发作.结论 脑电图背景活动正常,中央及颞叶儿童癫痫是一种特殊癫痫综合征,预后良好,正确认识临床特征和脑电图特点是诊断和治疗的关键.     

64例儿童失神癫痫的临床与脑电图表现

目的探讨64例儿童失神癫痫的临床特点、诊断方法及脑电图表现。方法64例儿童失神癫痫患者均做神经系统检查和多次脑电图检查。结果失神癫痫主要表现为持续数秒至数十秒短暂的精神活动中断,意识丧失,发作和终止均甚突然,一般不伴抽搐,通过脑电图常规检查和诱发试验,大多显示阵发两侧同步3Hz棘慢波等痫性放电。结论儿童失神癫痫属全身性发作,是小儿癫痫中常见的类型,主要表现为突然短暂的意识丧失,脑电图检查对诊断和鉴别诊断有重要意义。     

长程脑电图监测诊断婴幼儿发作性事件的价值

目的 研究长程脑电图监测对不能依靠临床症状、体征及常规脑电图诊断的婴幼儿发作性事件的诊断价值.方法 近3年半来因发作性事件首次在西安交通大学医学院第二附属医院儿科门诊及住院诊治,不能依靠临床症状、体征及常规脑电图诊断的2岁以下婴幼儿136例.给予长程脑电图监测得到初步诊断为癫痫事件或非癫痫事件,再根据症状、体征、头颅CT、血糖、血氨、心肌酶谱、心电图、骨碱性磷酸酶、甲状腺功能,以及用抗癫痫药物治疗后的反应等,得到确定诊断.结果 ①长程脑电图初诊癫痫发作 81例(59.6%),非癫痫发作 55例(40.4%);53例(39.0%)监测到发作性事件的婴幼儿中有22例(41.5%)有发作时同步的痫样放电,初诊为癫痫发作,有31例(58.5%)发作时无同步痫样放电,且这31例中12例(38.7%)有发作间期痫样放电,初诊为非癫痫发作;83例(61.0%)未监测到发作性事件出现的婴幼儿中有59例(71.1%)在发作间期有痫样放电,初诊为癫痫发作,24例(28.9%)未见痫样放电,初诊为非癫痫发作.②80例(58.8%)患儿确诊为癫痫发作,56例(41.2%)确诊为非癫痫发作.③癫痫发作错诊及漏诊均发生在83例未监测到发作性事件的婴幼儿中,长程脑电图监测初诊的59例癫痫发作中有3例(5.1%)被排除,非癫痫发作24例中有2例(8.3%)被诊断为癫痫发作.长程脑电图诊断癫痫发作及非癫痫发作的诊断符合率分别为96.3%和96.4%,比较无统计学差异(χ2=0.197,P>0.05),总体诊断符合率为96.3%.结论 发作性事件就诊的婴幼儿,如果不能依靠临床症状、体征及常规脑电图明确诊断,应进行长程脑电图监测诊断或排除癫痫事件.     

24h动态脑电图监测对儿童癫痫的诊断价值

目的探讨24h动态脑电图在儿童癫痫与非癫痫发作性疾病诊断与鉴别诊断中的价值。方法2004年11月~2007年9月在我院癫痫专科门诊就诊的具有发作性症状儿童病例845例,其中拟诊癫痫554例,非癫痫性发作性疾病291例,全部病例均作常规脑电图(EEG)和24h动态脑电图(AEEG)检查。结果拟诊癫痫554例,经24h动态脑电图检查,结合其临床表现,确诊为癫痫491例;而拟诊非癫痫性发作性疾病291例,经24h动态脑电图检查,结合其临床表现,276例被除外癫痫。结论24hAEEG是鉴别诊断儿童癫痫与非癫痫发作性疾病的可靠检查方法。     

托吡酯添加治疗难治性部分性癫痫的脑电图研究

目的 探讨托吡酯添加治疗难治性癫痫部分性发作时对患者脑电图癫痫样波和背景活动的影响。方法 对54例难活性部分性癫痫患者进行托吡酯添加治疗，并在基础期、托吡酯加量期及稳定期进行常规脑电图检查。结果 加用托吡酯后，19％的患者发作停止，总有效率达65％；48％的患者出现轻-中度副反应。在治疗有效的患者(发作减少≥50％)发作间期癫痫样放电显著减少或消失，但有9．3％的患者癫痫样放电反而增多；托吡酯所致EEC背景活动异常(38．9％)表现为0活动和δ活动增多，α活动减少。结论 托吡酯是难治性癫痫部分性发作的有效辅助治疗药物，癫痫样脑电活动的减少平行于发作频率的减少；托吡酯必须在脑电图的监测下缓慢增加剂量以及早发现中枢神经系统副反应，与此相关的EEC变化为慢活动增多。     

脑电图临床应用的简介(下) 三、癫痫的脑电图

到目前为止,除了医师能目睹患者的发作是否象癫痫以外,脑电图是诊断癫痫的最有用的辅助工具,其他一些辅助诊断方法如CT等可以对发现某些引起癫痫的病因有助,但对患者是否有癫痫则帮助不大,当然只有一次脑电图检查,而患者的癫痫发作很稀少,或已服用相当剂量的药物,脑电图也不一定有阳性发现,如果多次反复检查,加以各种诱发试验和特殊电极的应用,那末脑电图诊断癫痫的阳性率就相当高了。下面对常见的痫样(性)放电作一简介。一般来说,凡是在原来背景电活动的基础上突然发生的高波幅放     

小儿癫痫的诊治

癫痫是小儿神经系统常见疾病之一 ,是多种病因引起的慢性脑疾病 ,是大脑神经元异常放电导致临床上出现发作性症状 ,其基本特点为短暂性、发作性和反复性。随着儿科疾病谱的改变 ,癫痫的发病率有增高的趋势 ,所以对于小儿癫痫及时准确的诊断和合理有效的治疗显得尤为重要。1癫痫的诊断癫痫的诊断一要靠病史 ,二要靠脑电图检查。1 1详细而准确的病史观察到典型的癫痫发作过程是确诊的重要依据。但由于癫痫是发作性疾病 ,就诊时患儿往往已经停止发作 ,加之有些病史叙述者也没有见到发作时的情况 ,或是受到医生的诱导而盲目地叙述病史 ,这就为癫…     

儿童孤独症谱系障碍合并癫痫的临床和脑电图特征分析

目的 分析孤独症谱系障碍(ASD)合并癫痫患儿临床和脑电图(EEG)特征,为临床完善ASD共患癫痫的诊疗提供线索.方法 选取2017年1月-2019年12月就诊于河北省儿童医院的120例ASD合并癫痫的患儿为研究对象,对其临床特点和EEG特征进行回顾性分析.结果 ASD合并癫痫患儿癫痫发作以局灶性发作(83.3％)为主...     

33例儿童腹型癫痫临床观察与脑电图分析

目的分析儿童腹型癫痫脑电图特点。方法用日本光电7314F型脑电图仪检查33例儿童腹型癫痫患者。结果33例儿童腹型癫痫患者,异常波主要为:(1)出现单个棘、尖-慢复合波7例;(2)出现阵发性中至高波幅θ活动10例;(3)出现阵发性中至高波幅δ活动3例;(4)枕、颞区一侧性局限性慢活动3例。脑电图异常23例,异常率为69.6%。全部病例均使用抗癫痫药治疗,经过6个月～2年治疗观察,20例腹痛发作完全控制,9例发作次数明显减少,治愈好转率达87.8%。结论脑电图检查对儿童腹型癫痫的诊断、鉴别诊断和预后都有重要的意义。     

33例儿童腹型癫痫临床观察与脑电图分析

目的 分析儿童腹型癫痫脑电图特点。方法用日本光电7314F型脑电图仪检查33例儿童腹型癫痫患者。结果33例儿童腹型癫痫患者,异常波主要为：（1）出现单个棘、尖一慢复合波7例;（2）出现阵发性中至高波幅θ活动10例;（3）出现阵发性中至高波幅8活动3例;（4）枕、颞区一侧性局限性慢活动3例。脑电图异常23例,异常率为69．6％。全部病例均使用抗癫痫药治疗,经过6个月～2年治疗观察,20例腹痛发作完全控制,9例发作次数明显减少,治愈好转率达87．8％。结论脑电图检查对儿童腹型癫痫的诊断、鉴别诊断和预后都有重要的意义。     

Changing the neurology policy landscape in the United States: Misconceptions and facts about epilepsy

Epilepsy has a relatively high prevalence, and diagnosis and treatment are often challenging. Seizure freedom without significant side effects is the ultimate goal for both physicians and patients, but not always achievable. In those cases, the treatment goals of patients and providers may differ. In the United States, many clinicians continue to prescribe older AEDs, even though newer AEDs have a more desirable safety and tolerability profile, fewer drug–drug interactions, and are associated with lower epilepsy-related hospital visits. Newer AEDs are more commonly prescribed by neurologists and epilepsy center physicians, highlighting the importance of access to specialty care. We report that antiepileptic drugs are not the dominant cost driver for patients with epilepsy and costs are considerably higher in patients with uncontrolled epilepsy. Poor drug adherence is considered a main cause of unsuccessful epilepsy treatment and is associated with increases in inpatient and emergency department admissions and related costs. Interventions and educational programs are needed to address the reasons for nonadherence. Coverage policies placing a higher cost burden on patients with epilepsy lead to lower treatment adherence, which can result in higher future health care spending. Epilepsy is lagging behind other neurological conditions in terms of funding and treatment innovation. Increased investment in epilepsy research may be particularly beneficial given current funding levels and the high prevalence of epilepsy.     

异基因造血干细胞移植后并发癫痫病8例的临床分析

[目的]总结分析异基因造血干细胞移植后并发癫痫病例的临床特点,加强对移植后癫痫的认识。[方法]观察接受异基因造血干细胞移植的病人,针对并发癫痫的病例,描述性分析其临床规律和特点。[结果]在104例接受异基因造血干细胞移植的病人中,有8例病人并发癫痫,发病率为7.69%。移植后癫痫的发生诱发因素为:药物、颅内出血、系统性真菌感染以及代谢性脑病。急性移植物抗宿主病(aGVHD)也常常与癫痫相伴。癫痫患者中患病后存活率低,仅有3例病人存活,死亡率高达75.00%。[结论]异基因造血干细胞移植术后患者并发癫痫预后差,积极处理诱发因素是最重要的癫痫防治措施。     

Routine EEG vs. intensive monitoring in the evaluation of intractable epilepsy

Appropriate treatment of patients with intractable seizures requires precise identification of the type (or types) of seizure the patient experiences and correlation of this information with data from electroencephalography localizing the focus of the seizure in the brain. For such patients, the technique of "intensive monitoring" has gained rapid acceptance in the past several years as the investigative method of choice.Intensive monitoring usually entails prolonged electroencephalographic recording with simultaneous videotaping of the patient. Another common technique is prolonged monitoring of the patient's electroencephalogram (EEG) by radiotelemetry, during which time the patient is closely observed by trained personnel for suspected seizures.To compare the quality of information obtained from intensive monitoring with that from careful routine electroencephalography, the authors reviewed the medical records of 100 consecutive patients who had received both kinds of study after being referred for treatment in the special Epilepsy Treatment Unit of the University of Minnesota's Comprehensive Epilepsy Program (CEP).Success of each method was defined by ability to record an actual seizure. The routine EEG examination recorded actual seizures in 7 percent of patients in the study. With video EEG, following careful withdrawal of anticonvulsant drugs, seizures were recorded in 70 percent of patients. Telemetered EEG recorded seizure activity in 50 percent of those patients for whom the other two methods had failed to detect seizures.Intensive monitoring revealed that 60 percent of patients for whom the routine EEG study had recorded only one seizure type actually suffered from two or more types. Clinical diagnosis was changed in 84 percent of the patients. In this study, intensive monitoring was found to be far superior to the routine EEG examination as an aid to precise diagnosis of intractable seizure disorders.     

慢性肾脏病合并丙型肝炎病毒感染诊断、治疗和预防的临床实践指南(2023年版)

丙型肝炎病毒(HCV)感染在慢性肾脏病(CKD)患者中高发,CKD患者在抗HCV治疗方面具有特殊性。随着直接抗病毒药物(DAA)问世并广泛应用于临床,CKD患者合并HCV感染的预后获得极大改善。近年来HCV治疗领域进展迅速,多种DAA相继在国内获批上市。为此,我国肾脏病、感染病、肝病和感控专家在2019年发表的《慢性肾脏病合并丙型肝炎病毒感染诊断及治疗的专家共识》基础上,以国内外临床研究进展为依据,结合现阶段我国实际情况,更新形成了本指南,以期为CKD合并HCV感染患者的规范化诊治提供指导性建议。     

The treatment of epilepsy in developing countries: where do we go from here?

Epilepsy is the most common serious neurological disorder and is one of the world's most prevalent noncommunicable diseases. As the understanding of its physical and social burden has increased it has moved higher up the world health agenda. Over four-fifths of the 50 million people with epilepsy are thought to be in developing countries; much of this condition results from preventable causes. Around 90% of people with epilepsy in developing countries are not receiving appropriate treatment. Consequently, people with epilepsy continue to be stigmatized and have a lower quality of life than people with other chronic illnesses. However, bridging the treatment gap and reducing the burden of epilepsy is not straightforward and faces many constraints. Cultural attitudes, a lack of prioritization, poor health system infrastructure, and inadequate supplies of antiepileptic drugs all conspire to hinder appropriate treatment. Nevertheless, there have been successful attempts to provide treatment, which have shown the importance of community-based approaches and also indicate that provision for sustained intervention over the long term is necessary in any treatment programme. Approaches being adopted in the demonstration projects of the Global Campaign Against Epilepsy--implemented by the International League Against Epilepsy, the International Bureau for Epilepsy, and the World Health Organization--may provide further advances. Much remains to be done but it is hoped that current efforts will lead to better treatment of people with epilepsy in developing countries.     

Functional imaging (PET and SPECT) in epilepsy]

Epilepsy is one of the most prevalent neurologic disorders and affects approximately 1% of the population. Most complex seizures arise from the temporal lobes and the condition of 20-30% of these patients is refractory to medication. Many can be rendered seizure free with surgery. Epilepsy surgery requires accurate identification of the site and extent of the epileptogenic area responsible for seizures. EEG is accepted as a gold standard, however only 50% of the patients are safely diagnosed. The need for invasive monitoring with possible hemorrhage or infection has been greatly reduced by the introduction of new technologies such as PET, SPECT and MRI in the clinical practice. MRI demonstrate morphologic changes in approximately 80% of patients with epilepsy. However, structural lesions may not always correlate with clinical, EEG and pathologic localization of epileptogenic foci. Seizures are associated with pronounced changes in regional cerebral blood flow. The real power of SPECT lies in the opportunity of ictal examinations, with a sensitivity ranging from 90 to 97%. Interictal PET studies using 18F-FDG measure regional glucose metabolism, have been investigated for their value as non-invasive focus-localizing techniques. These studies have sensitivity ranging from 80 to 85%. The benzodiazepine binding site that are associated with and modulate the activity of GABA receptors have been imaged by SPECT (using 123I-iomazenil) and PET (using 11C-Flumazenil). Combined measurements of benzodiazepine binding sites and perfusion/metabolism provide a more accurate visualization of epileptogenic site than perfusion or metabolism measurements alone. Functional imaging modalities (PET and SPECT) are highly important in the presurgical evaluation of patients with medically refractory complex partial seizures.     

Epileptic seizure detection in EEG signal using machine learning techniques

Epilepsy is a well-known nervous system disorder characterized by seizures. Electroencephalograms (EEGs), which capture brain neural activity, can detect epilepsy. Traditional methods for analyzing an EEG signal for epileptic seizure detection are time-consuming. Recently, several automated seizure detection frameworks using machine learning technique have been proposed to replace these traditional methods. The two basic steps involved in machine learning are feature extraction and classification. Feature extraction reduces the input pattern space by keeping informative features and the classifier assigns the appropriate class label. In this paper, we propose two effective approaches involving subpattern based PCA (SpPCA) and cross-subpattern correlation-based PCA (SubXPCA) with Support Vector Machine (SVM) for automated seizure detection in EEG signals. Feature extraction was performed using SpPCA and SubXPCA. Both techniques explore the subpattern correlation of EEG signals, which helps in decision-making process. SVM is used for classification of seizure and non-seizure EEG signals. The SVM was trained with radial basis kernel. All the experiments have been carried out on the benchmark epilepsy EEG dataset. The entire dataset consists of 500 EEG signals recorded under different scenarios. Seven different experimental cases for classification have been conducted. The classification accuracy was evaluated using tenfold cross validation. The classification results of the proposed approaches have been compared with the results of some of existing techniques proposed in the literature to establish the claim.